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Stiitiie of Horace ^Vells, HartjoiJ, Connecticut 

PRESENTED TO 



BY THE J. M. NEY COMPANY 



Digitized by tine Internet Arciiive 

in 2011 witii funding from 

University of Toronto 



littp://www.arcliive.org/details/essayonteetlicompOOwell 



Reprinted for 
THE J. M. NEY COMPANY 

by 

CASE, LOCKWOOD & BRAINARD 

85 TRUMBULL ST.. HARTFORD 
1949 



AN ESSAY 



TEETH; 



COMPBISINC A BRIEF DESCRIPTION 



FORMATION, DISEASES, 



PROPER TREATMENT 



Bv HORACE WELLS, 



SURGEON DENTIST. 



HARTFORD. 
PRINTED FOR THE AUTHOR, 

BY CASE, TIFFANY & CO., PEARL-STREET, 
1838. 



TO 



MY BROTHER, 



CHARLES WELLS, M. D 



ITKID© W©[^K 



IS MOST AFFECTIONATELY 



INSCRIBED. 



ADVERTISEMENT 



It is not intended, by this small treatise, to give a 
full, anatomical description of Teeth, with their 
diseases, and method of cure. This can only be done 
in a much larger and more systematic work. The 
object of this volume is to impart that information 
respecting the hvunan teetli, which should be fa- 
miliar to the mind of every individual. 

It is a lamentable fact, that a large proportion 
of our citizens, and those, too, the most enUght- 
ened on other subjects, are but httle acquainted 
with the nature of these invaluable organs, de- 
manding the utmost care for their health and 
preservation. They are liable to be injured or 
wholly destroyed by the use of improper denti- 
frices, as well as by neglect. It is important that 
those who desire a good set of teeth should be 
acquainted with the destroying agents, causing 
their premature decay. It is beheved that this sub- 
ject will be found satisfactorily discussed in the 
following pages. If the author has differed in 



VI ADVERTISEMENT 

opinion from other writers on any point, he has 
not failed to give his reasons for so doing, leaving 
the reader to judge of their soundness. In his 
opinion, popular errors exist, which, in many in- 
stances, arise from deep rooted prejudices, several 
of which in this work have been duly considered 
and impartially discussed. 



CONTENTS. 



Formation and development of Teeth, 


13 


Organization of Teeth, 


27 


Caries of Teeth, 


32 


Cause of Caries, .... 


36 


Tooth-ache, 


48 


Diseases of the Fangs of Teeth, . 


58 


Cleansing of Teeth, .... 


61 


Dental Surgery, 


64 



FORMATION AND DEVELOPMENT 
OF TEETH. 



Prior to the existence of any sub- 
stance which may be termed an em- 
bryo tooth, Nature provides a founda- 
tion for the reception of those rudi- 
ments, soon to develope, and assume 
a hard, osseous structure, called teeth. 
This foundation consists of maxillary, 
or jaw bones, slightly excavated, for 
the purpose of retaining a deposite, 
destined to become some of the most 
useful and ornamental organs in the 
whole human system. When the teeth 
first make their appearance in these 
excavations of the jaw, they are of a 
soft, gelatinous substance, completely 
enveloped by a thin membranous 



14 FORMATION AND 

covering. At this period, Nature is 
very curiously at work, in constructing 
a partition of bony fibres, between 
these pulpy bodies, thereby forming 
a separate cell for each advancing 
tooth. Ossification soon commences, 
rendering the surface of these, as yet, 
imperfect bodies, quite hard, and im- 
pervious to all foreign substances. The 
fangs, or roots, commence their 
growth by a gradual elongation of 
these pulps, while an earthy sub- 
stance, possessing a most beautiful 
polish, called the cortex striatus, or 
enamel, is in progress, extending itself 
over that portion of the young tooth, 
which is eventually to be exposed, and 
called the body or crown. As the tooth 
rises in the socket, an absorption of 
the capsule and gum over its upper 
surface, follows, as a matter of course. 
This is a very important operation in 



DEVELOPMENT OF TEETH 15 

the animal economy; for if it were not 
the case, a serious laceration of those 
membranous coverings would be the 
consequence: it would then, in reali- 
ty, be what it is now improperly 
called, the "cutting of teeth." During 
the formation of teeth, the alveolar 
process is in a state of rapid progres- 
sion. The pulps, being quite loose in 
their sockets, require a support. For 
this purpose, the alveoli grow much 
faster than the teeth, previous to their 
development— so much so, that at the 
time of birth, they are nearly covered 
with this bony texture. Were it not 
for this, there could be no pressure on 
the gum without injury to the teeth 
beneath it. The process of teething is 
frequently attended with painful 
diseases, caused by difficult dentition. 
The whole system of the child is sus- 
ceptible of morbid impressions; and 



16 FORMATION AND 

such sympathy exists between the 
diEerent organs, that one imbibes 
disease from the other. Children are 
hable, while teething, to fever, spas- 
modic affections of the limbs, and fre- 
quently convulsions of the whole 
frame. It is too often the case that 
parents and nurses, desirous of seeing 
the little sufferer freed from pain, re- 
sort to those means which go directly 
to defeat their purpose. It is a common 
idea that the teeth cut their way 
through the gum; and to facilitate this 
operation, hard substances are given 
to the child, to use in the mouth, it 
being supposed that this unnatural 
pressure on the gum must assist the 
teeth in their effort at laceration. This 
practice cannot be too seriously con- 
demned. It has undoubtedly brought 
many a child to an untimely grave, by 
exciting inflammation and fever. In 
some instances, it may be judicious 



DEVELOPMENT OF TEETH 17 

to separate the gum over the teeth, 
witli a sharp lancet: and when tliis is 
absolutely necessary, if it is not per- 
formed by the hand of a skilful oper- 
ator, an irreparable injury may be the 
result. 

The denies sapientiae, or, as they 
are sometimes called, the wisdom 
teeth, appear at a late period, fre- 
quently causing much pain, and with- 
al being very troublesome after their 
protrusion. This results from the ir- 
regular position which they take to- 
wards the cheek. It is seldom neces- 
sary to extract them on that account, 
for nature will always yield, to ac- 
commodate her own deformities. 

It is impossible to state the exact 
time of the appearance of the teeth 
through the gums. They appear some- 
times at as early as the fifth, and again 
as late as the tenth month after birth; 



18 FORMATION AND 

generally, however, between the sixth 
and eighth. It is asserted of Louis 
XIV., of France, and the Emperor 
Napoleon, that they were bom with 
the two anterior incisores of the lower 
jaw already formed and developed. 
This variation of time, no doubt is ow- 
ing, in a measure, to the general 
health of the child. Bad health natu- 
rally retards the progress of the teeth. 
They commonly appear in pairs : 

1st. The two anterior, or central 
front incisores of the lower jaw, im- 
mediately followed by the two cor- 
responding upper ones : 

2d. The bicuspides, or the small 
double teeth of the under jaw, with 
their corresponding ones in the upper: 

3d. The molares, or large double 
teeth of the under jaw, followed by 
those in the upper. 



DEVELOPMENT OF TEETH 19 

Thus far, we have been speaking 
of the deciduous or temporary teeth. 
At an early period of their formation, 
a process is observed departing from 
tlie main body, containing the seeds 
or rudiments of the permanent teeth. 
The question will naturally arise, 
where does this new bud find room in 
the alveolus? It is truly wonderful to 
notice the operation. There exists no 
pressure in the cavity, arising from 
this new process; and yet the alveolus, 
or cavity, is enlarged in proportion to 
the growth of the pulp, or young 
tootli. This is accomplished by various 
absorbing vessels, always ready for 
the performance of any task assigned 
them. For some length of time, there 
exists a connexion between the two, 
and both are contained in the same 
cavity; but as they advance towards 
perfection, a distinct alveolus is as- 



20 FORMATION AND 

signed for each. This is effected by 
the deposition of a bony substance 
between them, f acihtated by their mu- 
tual progress. When the temporary 
teeth have made their appearance, 
the rudiments of the permanent ones 
are situated behind them, extending 
deeper into the maxillary bone, and 
having the same connexion with the 
surrounding parts, that the mother 
teeth possessed before their develop- 
ment. 

It is highly important that parents 
should be acquainted with the relative 
position of the two sets of teeth, the 
time of change, etc. Many are the evils 
arising from the injudicious manage- 
ment of the temporary teeth, by pro- 
fessed dentists, who, through pre- 
sumption and ignorance, are ever 
ready to perform any operation, if re- 
quested by the parent, who is not 



DEVELOPMENT OF TEETH 21 

competent to decide what should be 
done. In the majority of cases, the aid 
of a dentist is not requisite. Nature 
seldom fails to perform her own work 
well, but there are instances where 
the assistance of a judicious and ex- 
perienced dentist is indispensable; 
and it is the duty of the parent to de- 
termine when this period arrives. 

The first teeth generally become 
loose, so that they may be removed 
by the pressure of the tongue, or with 
the fingers. It is a mistaken idea that 
loose teeth are the only ones to be 
removed, when the permanent teeth 
have the appearance of protruding in 
an irregular position. It is sometimes 
the case that those which are loose 
had better remain, while those which 
are perfectly firm in their sockets 
should be removed. In the first in- 
stance, we see the process of absorp- 



22 FORMATION AND 

tion going on at the root, bidding fair 
for a speedy removal of the tooth; 
while in the last case, it is evident the 
absorbants have not been excited, or 
not suJBficiently so to remove the root, 
in proportion to the growth of the 
second tooth; thus giving the latter a 
different direction from what nature 
intended it should take. 

It is my lot to witness almost daily, 
serious evils resulting from a prema- 
ture removal of the first teeth. In ob- 
serving individuals with very irregu- 
lar teeth, I generally find, on inquiry, 
that they are victims to the absurd 
treatment above alluded to. I am fre- 
quently requested by parents to re- 
move the two first lateral incisores of 
the upper jaw, because the central 
ones of the second set, which precede 
them, have the appearance of being 
too much crowded, and lack for room 



DEVELOPMENT OF TEETH 23 

— tlie thought not even suggesting it- 
self to the parent's mind, that room 
must also be preserved for the per- 
manent ones, adjoining those which 
have already made tlieir appearance. 
There are other evils arising from this 
worse than useless practice, but this 
one is sufficient to caution every per- 
son, having the care of children, not 
to be too hasty in the removal of their 
temporary teeth, but to let them re- 
main until they are ready to fall out 
of themselves, unless they become too 
troublesome to be endured. 

It has been a matter of speculation, 
with different writers, whether the first 
teeth are removed from their sockets 
by the growth and pressure of their 
successors— that is, whetlier the ab- 
sorption of the temporary roots is oc- 
casioned by the upward pressure of 
the permanent ones, or, whether the 



24 FORMATION AND 

Operation of shedding the teeth is an- 
ticipated, and absorption takes place 
without any other apparent cause. The 
former is the commonly received 
opinion, but I must beg leave to differ. 
Yet I will not pretend to give my 
opinion, without presenting some ar- 
gument for its support. In the first 
place, absorption does not commence 
at the extremity but at the distance of 
half an inch from the termination of 
the root. Another argument, to show 
that the absorbents act spontane- 
ously, is, that before the rudiments of 
the secondary teeth make their ap- 
pearance, absorption has already com- 
menced, and that too in the cancelli 
of the bone, where no pressure could 
exist. Again, when the lining mem- 
brane, which covers the crown of a 
new tooth, has fulfilled the office for 
which it was intended, it disappears, 



DEVELOPMENT OF TEETH 25 

without the aid of pressure. Bunon 
even went so far as to suppose that 
the roots of teeth were reduced to a 
fine powder by actual abrasion or 
wearing. Bourdet gives it as his opin- 
ion, that acrid humor is secreted to 
act as a solvent. Van Sweiten ad- 
vances an opinion fully as absurd. 
Speaking of the opinions advanced by 
these two authors, on tliis subject, he 
adds; "I confess it appears much more 
probable that the milk teeth are with- 
out roots; nevertheless, some observa- 
tions seem to show that the milk teeth, 
if tliey are not shed at the proper peri- 
od, or, when loose, not taken out, are 
capable of protruding roots from 
themselves, by means of which they 
often remain fixed in the jaw through 
life." 

It is a well-known fact, that the first 
teeth have roots; and these are larger, 



26 FORMATION, &C. OF TEETH 

in proportion to the size of the crown, 
than those which appear at a later 
period. The change of a temporary 
for a permanent set of teeth varies, 
but as a general rule, the 



Anterior Molares change 


from 


5 to 


7 years 


Central Incisores, 




6 " 


8 " 


Lateral 




7 " 


9 " 


Anterior Bicuspides, 




8 " 


10 " 


Posterior 




9 " 


11 " 


Cuspidati, 




10 " 


12 " 


Second Molares, 




11 " 


13 " 


Dentes Sapientiae, 




18 " 


21 " 



ORGANIZATION OF TEETH. 



Are the teeth extraneous bodies, 
with respect to a circulation through 
their osseous substance? This ques- 
tion, two or tliree able writers have 
answered in the affirmative, and at the 
same time, brought forward several 
arguments to favor the supposition. 
That the bone of a tooth does contain 
nerves, blood-vessels, and absorbents, 
can be proved beyond a doubt, (a 
question involving very important 
principles in the surgical treatment of 
teeth. ) It is evident tiiat they are not 
extraneous bodies, from the fact that 
the progress of caries excites inflam- 
mation in their bony structure, there- 
by causing pain previous to their com- 



28 ORGANIZATION OF TEETH 

ing in contact with the nerve and 
Hning membrane of the internal cavi- 
ty. Another argument in favor of this, 
is, that the teeth of those animals fed 
on madder for some length of time, 
change from a white to a reddish hue, 
and were it not for their vascularity, 
it would not be the case. 

Hunter observes: "a strong circum- 
stance in support of the teeth having 
no circulation in them, is, that they 
never change by age, and seem never 
to undergo any alteration, when com- 
pletely formed, but by abrasion. They 
do not grow softer, like the other 
bones, as we find in some cases where 
we find the whole earthy matter of 
the bones has been taken into the 
constitution." I do not know how long 
time Mr. Hunter would allow for the 
teeth to become "completely formed;" 
but if his remark is true, an age of 



ORGANIZATION OF TEETH 29 

75 or 100 years would not be suffi- 
ciently long. After the entire destruc- 
tion of the vessels which enter the ex- 
tremity of a root, (thus depriving it 
of nourishment from this source,) it 
generally requires but one or two 
years for this ( now in a measure ) ex- 
traneous body, to become of a dark 
hue, possessing the appearance of a 
dead substance. It is in fact no un- 
common case, on the extraction of 
these teeth, to find their roots reduced 
to a cartilaginous substance. Mr. 
Hunter was not a practical Dentist, 
but a very able Surgeon, and writer; 
had he attended to the practical part 
of Dental Surgery, it is not improba- 
ble that his opinion on this subject 
would have met with a material 
change. That a tooth cannot be in- 
jected, may be accounted for when we 
consider the comparatively coarse in- 



30 ORGANIZATION OF TEETH 

gredient used for this purpose; for the 
extreme tenuity of the vessels will 
not admit of any coloring matter be- 
ing artificially applied for the purpose 
of their injection. The bone of the 
tooth is of so dense a structure, that 
it is not at all wonderful that they are 
not frequently tinged with blood 
when in a state of inflammation. The 
numerous vessels, permeating its 
whole structure, have no room for dis- 
tention. 

A lady once called on me, for the 
purpose of asking my advice respect- 
ing a central incisor, of the upper jaw 
which had caused pain, and was at 
the time, highly inflamed. On exami- 
ning the tooth closely, I could dis- 
tinctly see a portion of the osseous 
structure, tinged with blood, which 
proved the existence of blood vessels 
in that portion of the tooth denomi- 
nated extraneous. 



ORGANIZATION OF TEETH 31 

The internal cavity of a tooth is 
coated with a vascular membrane, 
while the external surface of the fang 
is covered by a periosteum, or lining 
membrane, both imparting vitality to 
the tooth. If there were not a nervous 
connexion between tliese membranes 
and the tooth, it would be difficult to 
assign a reason for their existence, as 
all organs have an important office to 
perform. One more argument, and I 
close. It is a well-known fact, that 
when the roots of teeth become de- 
nuded, by the absorption of tlie alveo- 
lar process, and gum, that the perios- 
teum also disappears, leaving the bone 
entirely bare. On the application of 
an instrument to those parts, thus de- 
nuded, an exquisite pain is produced, 
which could not be the case, were it 
not for the existence of nerves perme- 
ating the bone. 



CARIES OF TEETH. 



Caries is a term applied to a disease 
of the teeth which is ahnost univer- 
sal. It is a decomposition of their os- 
seous structure, transforming a beau- 
tiful, hard substance into a putrid and 
offensive mass. The exciting cause of 
this transformation may be attributed 
to different sources; but whatever may- 
be the cause, its effect is a certain 
destruction of the tooth attached, if 
it is allowed to remain neglected. 

As to the general location of this 
disease in its first stages, much has 
been said and written. Bell aflfirms 
that "it invariably shows itself on the 
external surface of the bone, immedi- 
ately underneath the enamel; and its 



CARIES OF TEETH 33 

existence is, in many cases, first indi- 
cated by a partial breaking down of 
its crystalline structure; in others its 
presence is shown by the discolored 
bone being seen through the semi- 
transparency of the enamel. If at this 
stage of the disease, the tooth be 
sawn through at that part, so as to 
intersect its centre, a brown mark will 
be found in the bone immediately un- 
der the opaque spot of the enamel, 
extending more or less into the sub- 
stance of the tooth, in a line tending 
directly towards the cavity. It is dark- 
est at the surface, where, from the 
disease having commenced at that 
part, its progress is more advanced, 
becoming gradually lighter towards 
the centre." 

All writers concur in saying that the 
disease sometimes commences under 
the enamel; but we seldom meet with 



34 CARIES OF TEETH 

a writer who takes the same ground 
as Mr. Bell. His theory cannot be sup- 
ported by every-day observation of 
facts. In lieu of discovering the 
opaque spot, (mentioned by Mr. Bell) 
on the surface of the bone immedi- 
ately underneath the enamel, we find 
it on the surface of the enamel; and 
at its first appearance it may be re- 
moved by a cutting instrument, with- 
out removing the crystaline structure 
sufficiently to expose the bone. The 
crown or body of the tooth is usually 
the object of attack, those places be- 
ing preferred where the enamel is 
naturally thin, or has been made so 
by abrasion. Thus we find the front 
teeth are first diseased, at the point 
coming in contact with those adjoin- 
ing them, thereby preventing the full 
growth of the enamel. But sometimes 
the disease appears on the anterior 



CARIES OF TEETH 35 

surface of tlie teeth, being the result 
of mechanical operations, or most 
commonly of neglect, in permitting a 
most destructive deposite, commonly 
called tartar, to remain on the neck, 
and part of die crown. As soon as 
disease has made its way through the 
enamel, its progress is much more 
rapid, for it there meets with a sub- 
stance softer, and consequently more 
liable to decay. It takes a course di- 
rectly towards the internal cavity; and 
on reaching the main nerve, its pro- 
gress is announced by most excruci- 
ating pain, and soon the whole crown 
disappears. 



CAUSE OF CARIES. 



Mr. Fox, in his excellent work, 
maintains that diseases of the teeth 
are, in every respect, analogous to 
those of bones in general— their cause 
being an inflammation of the hning 
membrane, and a consequent separa- 
tion of it from the bone. To make the 
last assertion appear the more plaus- 
ible, he cites a case in which the peri- 
osteum being separated, will cause 
death to a portion of the tibia. 

Mr. Bell, in reply to this view of 
the question, remarks: "exclusive of 
the circumstance that caries is, in 
this passage, confounded with necro- 
sis, it contains, in every respect, a 
false view of the question. It is extra- 



CAUSE OF CARIES 37 

ordinary that this author, arriving as 
he did at so near an approximation to 
the true causes of the disease, should 
have at once confounded not only 
caries with gangrene, but partial gan- 
grene with the total death of the 
tooth." 

Mr. Bell, however, so far agrees 
with Mr. Fox, as to assign the proxi- 
mate cause of disease to inflammation, 
and this takes place in the following 
manner: "When from cold, or from 
any other cause, a tooth becomes in- 
flamed, the part which suffers most 
severely is unable, from its possessing 
comparatively but a small degree of 
vital power, to recover from the ef- 
fects of inflammation, and mortifica- 
tion of that part is the consequence. 
That the bony structure of the teeth is 
liable to inflammation, appears not 
only from the identity of the symp- 



38 CAUSE OF CARIES 

toms which takes place in them when 
exposed to causes likely to produce it, 
with those which are observed in the 
other bones when inflamed; but more 
conclusively still from the fact already 
mentioned, that teeth are occasionally 
found, in which distinct patches, in- 
jected with the red particles of blood, 
have been produced by this cause 
after the continuance of severe pain." 
That teeth are subject to inflamma- 
tion, I do not pretend to deny; but, 
as a general rule, that they first be- 
come defective in consequence of in- 
flammation, will, I think, admit of a 
question. To decide this question, it 
is necessary to make it appear wheth- 
er decay commences upon the exter- 
nal surface of the enamel, or not. If 
this can be satisfactorily decided in 
the afiBrmative, it is evident that in- 
flammation is not the primary cause 



CAUSE OF CARIES 39 

of caries. I have before alluded to a 
fact, which, to my mind, is perfectly 
conclusive, viz., that at the first ap- 
pearance of disease, the opaque spot 
may be wholly removed without pen- 
etrating to the bone; and it is perfectly 
natural to suppose that any liquid, 
possessing the eroding property suffi- 
ciently to act upon silver, and even to 
tarnish gold, coming constantly in 
contact with the teeth, would also 
act upon them. Such is the nature of 
the saliva of the mouth; and where we 
find that extremely vitiated we are 
sure to find bad teeth. I therefore set 
this down as one of the principal 
agents in causing caries. And if this 
is true, it must, as a matter of course, 
act first upon that portion of the 
enamel coming in contact with it, 
which is the external surface. 

When a tooth once becomes dis- 



40 CAUSE OF CABIES 

eased, it tends to vitiate the saliva, 
thus causing it to act with greater ef- 
fect upon those which are healthy. 
Another agent in this matter, may be 
attributed to particles of food remain- 
ing between the teeth, which soon 
putrify, thus acting with a pernicious 
effect upon the general health of the 
mouth. In short, whatever has a direct 
tendency to produce caries, also con- 
tributes to vitiate the saHva. 

Tartar is a foreign substance, which 
acts chemically upon the teeth, there- 
by directly causing their decay. It is 
composed of Phosphate of Lime, fa- 
brina, or cartilage, and animal fat, or 
oil. It insinuates itself between the 
gum and neck of the tooth, sometimes 
nearly covering the crown, producing 
an unhealthy state of the gums. I have, 
in several instances known it to col- 
lect to such an unsightly mass as to 
envelope the teeth. 



CAUSE OF CARIES 



41 



One person who called on me in 
this state, was exceedingly alarmed; 
not knowing its nature, but supposing 
it to be the result of exostosis, or a 
freak of nature, in throwing up a solid 
mass of jaw to answer for the organs 
of mastication, in lieu of teeth. On 
denuding the teeth of this incum- 
brance, her delight scarcely exceeded 
her astonishment, on discovering that 
she had teeth like other people. 

There are those who are never 
troubled with this corrosive substance, 
even while they are perfectly negli- 
gent of their teeth; while others can 
scarcely prevent its accumulation by 
the utmost care and diligence, in the 
use of proper means. This difference 
may be attributed, in a measure, to 
peculiarities of the constitution; but 
we almost invariably find exciting 



42 CAUSE OF CABIES 

causes before mentioned, where it ac- 
cumulates in a remarkable degree. 

Caries is caused by the enamel be- 
ing weakened or destroyed by any 
mechanical operation. This is fre- 
quently done by ignorant practition- 
ers, who do not hesitate, while cleans- 
ing the teeth, to remove also a portion 
of the tooth itself, in order to make it 
perfectly white. Acid is sometimes 
used for the same purpose. This for 
a time gives satisfaction. The teeth 
present a beautiful external appear- 
ance after such an operation. But a 
few days will effect sad changes, and 
the teeth assume a dead appearance. 
The saliva acts with renewed vigor, 
until it finally effects an entrance to 
the bone. 

The enamel is frequently made thin, 
or entirely worn away, by mastication. 
In such case, caries soon makes its ap- 
pearance. 



CAUSE OF CARIES 43 

It is frequently asked, why the ne- 
gro has a better and whiter set of 
teeth than the white man. This ques- 
tion has called forth various answers. 
Some assert that they have no better 
teeth than ourselves,— that it is owing 
entirely to the contrast of their black 
lips. Mr. Fitch endeavors to answer 
it, by saying, that it is owing to the 
rotundity of the jaw, peculiar to the 
negro; thus giving more space for the 
teeth. 

It is not owing to the rotundity of 
the jaw that gives more space for the 
teeth of a negro, but to the different 
angle which they take from the jaw. 
Mr. Fitch, notwithstanding, is per- 
fectly correct in assigning this fact as 
a reason why their teeth are healthier 
than ours, viz.— that having more 
space for their growth, the enamel at- 
tains a thickness which it otherwise 



44 CAUSE OF CARIES 

would not; but this is only one reason. 
It is doubtless owing in a measure, to 
difference in diet; for we frequently 
find that those colored persons, serv- 
ing in opulent families, have as bad 
teeth in a short time, as those with 
whom they reside. A simple diet is 
the surest preventive of disease in the 
teeth which can be recommended. 
Sumptuous fare might not act as a 
direct cause of caries, but it most as- 
suredly has its influence through other 
agents. If this statement requires 
proof, we need but look among our 
savage tribes, who Hve on coarse fare, 
and never experience the many in- 
firmities to which we are subject; but 
pass along to old age with good health, 
never requiring the aid of a dentist. 

It is a frequent remark, that our an- 
cestors were seldom troubled with the 
tooth-ache, and possessed much bet- 



CAUSE OF CARIES 45 

ter teeth than ourselves. This is doubt- 
less true; and it is no less true, that it 
was in consequence of living more in 
accordance with the common dictates 
of reason: Where they could make a 
simple article of food answer for a 
meal, and that, too, with a good relish— 
we must taste of three or four high 
seasoned dishes, some of which our 
good old forefathers, being ignorant 
of their polished names, would call 
heterogeneous jumbles. 

It is generally supposed that sugar 
and molasses, or, in fact, anydiing that 
is sweet, is highly injurious to the 
teeth. This is a mistake which may 
be attributed to the fact that confec- 
tionary, and nearly all compounds 
made rich, and extremely palatable, 
are deleterious. There is nothing more 
destructive to the teeth than a com- 
pound, (sugar being a component 



46 CAUSE OF CARIES 

part,) sold at nearly every corner of 
the streets, under the name of candy; 
most of which contains ingredients 
which act chemically— removing the 
enamel as if by magic. I was acquaint- 
ed with a young man, residing in the 
country, who had an excellent set of 
teeth. He came to the city, and con- 
nected himself with a confectionary 
establishment. In a short time his 
teeth were entirely ruined, in conse- 
quence of the frequent use of that ar- 
ticle which he made it his business to 
deal out to others. We find the teeth 
of all, who are constant visiters to 
these shops, more or less defective. 

It is often questioned whether to- 
bacco is injurious to the teeth. On this 
subject I will simply give a short ex- 
tract from the work of Longbotham, 
with whom I perfectly agree. 

"The smoking or chewing this herb 



CAUSE OF CARIES 47 

is frequently introduced, from the ve- 
hement pain of the tooth-ache, and 
with most constitutions paves the way 
to a far more dangerous disease than 
it is intended to remove, by its acrid 
and internally violent qualities, in the 
act of a fumigation, being inhaled; 
and the chemical oil which it leaves, 
within the hollows of the teeth, dis- 
poses them to blackness, and prema- 
ture decay; which, though less ob- 
noxious for the present, proves a last- 
ing enemy to the mouth and stomach." 



TOOTH-ACHE. 



This is of all pains the most severe. 
Indeed it is often a matter of wonder 
how a tooth, so diminutive in its con- 
struction, can be the cause of so much 
insupportable misery. Although the 
organ which may be diseased, is small, 
of itself, yet it has such an intimate 
connexion with others, that it ceases 
to be a wonder, when the whole ma- 
chine is taken into consideration. 

The tooth-ache is occasioned by an 
inflammation of the lining membrane 
of the tooth, which has become af- 
fected by causes already delineated. 
It is rendered the more painful, on 
account of the non-elasticity of those 
parts, coming in contact with the cap- 



TOOTH-ACHE 



illary arteries; which, on account of 
an increase of arterial blood, seek for 
distention, and in their eflForts to do 
this, occasion that peculiar sensation 
called the tooth-ache. 

This inflammation is generally ex- 
cited by the application of cold to the 
nerve of the internal cavity; but it is 
sometimes occasioned by an unnatu- 
ral pressure upon the nerve, either by 
particles of food forced into the cari- 
ous opening, or by introducing a plug, 
at an improper time, for the arrest of 
its further decay. This is frequently 
done by those who are not competent 
for the task which they undertake to 
perform. Yet there are cases, though 
seldom, when the most skilful and ex- 
perienced operator may be deceived. 

Where constant pain is caused by 
this means, it is best to dislodge the 
filling. In most cases, the pain will 



50 TOOTH-ACHE 

immediately cease, and by proper 
treatment the tooth may soon be pre- 
pared for the second operation with- 
out much fear of the return of pain. I 
would here allude to a circumstance, 
which is extremely apt to lead to an 
erroneous conclusion, and if possible, 
undeceive those who may be induced 
to think or speak unfavorably of a 
dentist who may have done his duty. 
It is no uncommon case that cold air 
or water will cause a momentary sen- 
sation in those teeth which are much 
decayed, and have been filled. This 
may be the case, when, previous to 
their receiving the plug, they were 
entirely free from sensation. It is a 
common conclusion, that if the cavity 
is completely filled, it is impossible 
for cold air or water to have any ef- 
fect upon the nerve; for, it is deemed 
impossible for cold or heat to find its 



TOOTH-ACHE 51 

way, nearly instantaneously, through 
a solid mass of gold. Those who be- 
lieve this, deny a fact, which is fa- 
miliar to the school boy who has paid 
any attention to the study of chemis- 
try, which teaches us that gold is one 
of the best conductors of heat and 
cold that has ever been discovered. 
So far from this circumstance proving 
that the gold does not fill the cavity 
properly, it is, on the contrary, an evi- 
dence that it has been made quite 
dense by compression, giving an op- 
portunity for a quick penetration of 
cold or heat. If, on the other hand, 
something soft, or even gold itself, 
were introduced without much com- 
pression, the tooth would, in all proba- 
bility remain insensible as before. 

If the nerve of the tooth is not ex- 
posed, this unpleasant sensation will 
wholly disappear in a few days, or at 
most, a few weeks. 



52 TOOTH-ACHE 

Whenever we hear a person com- 
plain of the tooth-ache, we take it for 
granted that his teeth are carious. In 
this, we are generally correct, but 
not always. The cavity of a tooth ap- 
parently sound, has been discovered 
to be filled with pus, the result of high 
inflammation of the lining membrane. 
This process would of course cause 
pain. Mr. Fox relates an instance of 
the kind. He observes: "some time 
ago, I was applied to by a gentleman 
who complained of an acute pain, 
arising from one of the molares of 
the under jaw. As I could discover no 
appearance of caries in it, I advised 
the loss of blood from the gums, with 
a view to remove tlie inflammation in 
the socket, or other parts connected 
with the tooth. 

"This treatment was by no means 



TOOTH-ACHE 53 

effectual, for the pain continued with 
scarcely an intermission. The gentle- 
man therefore determined to have the 
tootli extracted. In attempting this op- 
eration, the tooth broke off at the 
neck, and completely exposed the in- 
ternal cavity. Fortunately, this acci- 
dent proved to be satisfactory, as it 
afforded an opportunity of ascertaining 
the cause of the pain. The membrane 
hning the cavity of the tooth, had be- 
come so highly inflamed, that it had 
proceeded to supperation, and the 
cavity of the tooth was filled with pus. 
Immediately after the operation, the 
gentleman was perfectly relieved, and 
had no return of pain. In a similar case, 
instead of extracting the tooth, I 
should recommend the drilling of a 
hole in the neck of the tooth into the 
cavity in order to make an opening. 



54 TOOTH-ACHE 

by which the matter might escape." 

This doubtless would be a judicious 
operation, could we always be sure 
of the existence of pus in the cavity, 
when the immediate cause of the pain 
was not perceptible. I have extracted 
teeth which were perfectly sound, and 
found the roots covered with lymph, 
being the result of inflammation. A 
severe pain may seem to be located in 
a tooth of the lower jaw, whereas 
a defective tooth may be the real 
source, and located in the upper jaw. 

So insupportable is the pain of the 
tooth-ache, and its effectual remedy 
so revolting to most persons, it is no 
matter of astonishment that every 
nostrum which is offered for sale, with 
the assurance that it will effect a 
speedy cure, should be grasped with 
eagerness. Advertisements are daily 
appearing, announcing late and im- 



TOOTH-ACHE 55 

portant discoveries of some miracu- 
lous remedy for the tooth-ache, whch 
will not only free the tooth from pain, 
but will clear it from all impurities, 
and re-construct a new enamel over 
the cavity formed by caries. I will not 
specify any particular medicine thus 
offered for sale, but indiscriminately 
condemn the whole. A temporary re- 
lease from pain may perhaps be ef- 
fected. But, after all, the tooth re- 
mains in the head, and will cause only 
more severe suffering. It is no easy 
matter to destroy the whole nerve of 
a molar tooth. The part exposed may 
be paralyzed, while the main portion 
of it retains its vigor; and in this state 
it cannot remain without becoming 
the subject of inflammation, at some 
future day, if not immediately. It may 
be said, that when it is wholly de- 
stroyed there is an end of it, and con- 



56 TOOTH-ACHE 

sequently an end to pain for ever from 
that source. 

Where an extraneous substance is 
allowed to remain in the jaw, it is a 
cause of continual irritation, produc- 
ing in many instances the most in- 
veterate head-ache. 

We find that the eyes, ears, tongue, 
&c., may become deranged, by means 
of a decayed tooth. Where this is the 
case, the real cause of the mischief is 
not always known. In fact, I have 
known persons endure a violent ear- 
ache for a long time, the result of de- 
cayed teeth, and yet the sufferer was 
little aware of the fact. 

Persons who are not blessed with 
good health, frequently seek a differ 
ent climate, in order that they may in- 
hale an atmosphere which, perchance, 
will cure them. Now, on examining 
the mouths of a great proportion of 



TOOTH-ACHE 57 

tliese unhealthy persons, we ascertain 
tliat tliey are still receiving into the 
lungs, at every respiration, an effluvi- 
um which they would shudder to en- 
counter, if it proceeded from any other 
source. In fact they carry with 
them the sure means to destroy the 
efficacy of a healthy climate; and all 
this may be attributed to a decayed 
tootli. 

I will conclude this chapter by enu- 
merating some of the various disor- 
ders produced by bad teeth, viz.— tic 
douloureux, hypochondriasis, epilep- 
sy, sympathetic head-ache, palsy, 
hemicrania, hysteria, and rheumatic 
aflFections. I could give a case adapted 
to each of the above disorders, but for 
want of room shall omit them. 



DISEASES OF THE FANGS OF TEETH. 



Thus far, we have considered dis- 
ease as originating in the crown of a 
tooth. This is truly its principal seat; 
but the roots are also subject to it, 
from various causes. It may be the 
result of some constitutional afiFection, 
but more commonly of accident. Any 
considerable blow upon a tooth is li- 
able to produce inflammation and dis- 
ease at the root. 

A disease, which has the appear- 
ance of being analogous to that of 
other bones, has its origin in the in- 
ternal cavity. The membrane, and 
other vessels, are soon destroyed: the 
crown of the tooth becomes dark, and 
has the appearance of being an ex- 



DISEASES OF THE FANGS OF TEETH 59 

traneous body: the periosteum, cover- 
ing the root, is next inflamed; and the 
gums, from the communication of 
disease, assume an unhealthy appear- 
ance. At this period, if nothing is done 
to check its progress, a serious evil 
follows. An ofi^ensive matter is formed 
at the roots of the teeth, which seeks 
an opening through the gum— some- 
times discharging itself near the neck 
of the tooth, but most commonly tak- 
ing a course nearly at a right angle 
with the root. 

Exostosis is an accumulation of bone 
upon the fang of a tooth. This is, how- 
ever, of rare occurrence; but when it 
does appear, it cannot be numbered 
among the least of evils; for it is a sure 
destruction to one or more of the 
adjoining teeth. A dull pain is at first 
felt on one side of the jaw. At times 
it fixes upon a single tooth, which be- 
comes loose in consequence of the 



60 DISEASES OF THE FANGS OF TEETH 

absorption of surrounding parts, ex- 
cited by the disease under considera- 
tion. This must eventually be re- 
moved; and it has, in some instances, 
proceeded to such a degree as to ren- 
der the jaw almost toothless. This 
osseous deposite, which is the cause 
of so much evil, is nearly transparent, 
being unlike the natural bone of the 
tooth. It is extremely hard, and, in 
color, of a yellowish hue. 

This accumulation, in some in- 
stances, is very slow, thus giving an 
opportunity for the alveolus to en- 
large, in proportion to the increase of 
bone; in such case, the operation is 
attended without real pain; yet there 
is, in every case, at times, an uneasi- 
ness about those parts affected. Where 
absorption does not keep pace witli 
the deposition of bone, a severe pain 
will be the result, which has some- 
times been mistaken for tic doulou- 
reux. 



CLEANSING OF TEETH. 



There still exists a prejudice 
against the use of a brush, for the 
cleansing of teeth. It is considered by 
many, not only superfluous labor, but 
worse than useless, from the supposi- 
tion that so much friction on die 
enamel, must be injurious to it. A 
greater mistake could not exist. We 
might as well talk of wearing out any 
other part of the system by frequent 
cleansing. If any thing softer than a 
brush is used, it will not do the work 
effectually. There are instances where 
a brush has never been used, and yet 
the teeth have remained perfectly 
healthy; and these comparatively few 
cases have been introduced, as con- 



62 CLEANSING OF TEETH 

elusive arguments in favor of the ob- 
jection. 

I will here state one fact, which may 
be considered as a weighty argument 
in favor of the brush. Those teeth 
which are frequently cleansed with a 
brush, seldom or never decay on the 
anterior surface, which is exposed to 
the greatest friction, while the lateral 
surface, remaining untouched, first 
gives evidence of decay. 

There are many dentifrices used, 
which are decidedly injurious; and 
perhaps this fact has been the means 
of exciting so much undue prejudice, 
relative to the proper treatment of 
teeth, above considered. In selecting 
a powder, it should be remembered 
that it ought not to contain a particle 
of acid. 

I would recommend Peruvian Bark, 
pulverized, (which may be obtained 



CLEANSING OF TEETH 



at most of our apothecary stores,) in 
preference to any composition ofFered 
for sale as "superior tootli powder." 



DENTAL SURGERY. 



A FEW words respecting the dental 
profession may not be out of place, 
especially as no profession is more li- 
able to the abuses of quackery. 

Every trade requiring much intel- 
lectual cultivation, has, in this coun- 
try, a greater proportion of unquali- 
fied men in its ranks, than is the case in 
the enlightened parts of Europe. It is 
true, that in some branches of public 
improvement, we leave the old coun- 
try far behind: in other branches, 
however, Europe is far before us. The 
cause of this difference is found in 
the circumstances connected with the 
infantile age of our RepubHc. Our 
young men, in many cases, are not in 



DENTAL SURGERY 



65 



a condition to go through a course of 
study in the higher seminaries, and 
frequently those who do pass a col- 
legiate course, commence practice, in 
their various callings, immediately on 
the close of their four years' term. In 
Europe, most educated men are not 
only well educated, but, in multitudes 
of instances, are educated veterans; 
and young men before they presume 
to cope with them for public approba- 
tion, must pass, not four, or six, as in 
this country, but actually twelve, four- 
teen, or twenty years in the Universi- 
ties. Hence, in a greater proportion, 
(other things being equal,) than in 
this country, they understand well 
what they profess to understand; and 
hence they are likewise more de- 
pended on, and quackery has less 
chance of practising mischief, at least, 



66 DENTAL SURGERY 

in those circles not lower than our 
own. 

Those who are engaged in active 
business of any kind, while contem- 
plating real or imaginary difficulties, 
or privations, peculiar to their particu- 
lar calling, are apt to become discon- 
tented, and envy the condition of 
others who have been fortunate 
enough to select a different employ- 
ment. 

Here, those who become thus dis- 
contented can abandon any trade or 
profession whatever, and immediately 
place the word "Dentist" for a sign 
upon their doors, with impunity. 

There are instances however, where 
imperative duty demands a change of 
business. But there are no circiun- 
stances which will justify ignorant pre- 
tenders in an act so contemptible as 
that of imposing on the public, by 



DENTAL SURGERY 67 

offering services which they are in- 
capable of rendering, and in place of 
which, dealing out the seeds of dis- 
ease and death. 

I have said that duty, in some in- 
stances, demands a change of occupa- 
tion. If a young man selects the dental 
profession, with the intention of mak- 
ing it a business for life, and at length 
finds himself deficient in mechanical 
ingenuity, so that his operations prove 
ineffectual, it is then for his own in- 
terest as well as for the interest of 
those who might employ him, to aban- 
don the profession forever. It is gen- 
erally supposed, that if a dentist has 
been long established in business, he 
must, as a matter of course, be skil- 
ful; and frequently this is the only 
recommendation desired. I unhesi- 
tatingly assert that there are many 
who would not become good dentists, 



DENTAL SURGERY 



with ever so much practice, wholly 
for the want of that one indispen- 
sable qualification— natural mechani- 
cal skill. I have known those who have 
performed operations on teeth for 
many years, and then were unable to 
compete with others who could boast 
of but one years' experience. A skil- 
ful Dentist should in all cases be em- 
ployed. There are many who are in- 
different respecting this, and they 
imagine that any person can properly 
perform so simple an operation as that 
of filling the teeth, to arrest their de- 
cay. This is truly a great mistake; and 
not a few can testify to the fact from 
sad experience. 

However simple the operation of 
filling the teeth may appear, it is, in 
reality, the most complicated, as well 
as the most important branch of the 
profession. An ordinary Dentist may 



DENfTAL SURGERY 



69 



succeed in performing all otlier opera- 
tions tolerably well, while this remains 
beyond the reach of his skill. He may 
truly put gold into the tooth, and per- 
haps it will keep its place for some 
length of time; but if the work is not 
eflFectually performed, the decay will 
proceed as before, even if the gold 
remains. 

The teeth, being conspicuous orna- 
ments to the person, as well as useful 
auxiliaries in the animal economy, 
should be as much an object of care 
and preservation, as any of the bodily 
functions. It is well known what effect 
they produce on the lungs, stomach, 
&c., contributing to their freshness and 
sweetness, to the preservation of 
health and strength, or, by their dele- 
terious gases, bring on or hasten de- 
cay. Is it not a remarkable fact, that 
men of fifty or sixty years of age, and 



70 DENTAL SURGERY 

upwards, who have long enjoyed 
sound teeth, have the most vigorous 
health? 

Doubtless all are convinced of the 
importance of preserving the teeth, 
while the only question remains— 
what is the best method of treatment? 
In reply to this, I have only to say- 
first become acquainted with the na- 
ture of these organs, and of their 
destroying agents— and then let reason 
dictate.